Penetrating keratoplasty for corneal ectasia after laser in situ keratomileusis.

PURPOSE To improve the visual acuity of patients with progressive keratectasia following laser in situ keratomileusis (LASIK). METHODS Five eyes of four patients underwent penetrating keratoplasty for ectasia after LASIK: In one patient the second eye was operated on 10 months after the first keratoplasty. The pre- and postoperative refraction, best spectacle-corrected visual acuity, and topographic data were evaluated. RESULTS The preoperative refraction was -20.0 diopters (D) with high cylindrical values in all eyes at the time of surgery. After penetrating keratoplasty, mean spherical equivalent was -13.08+/-3.62 (SD) and mean refractive cylinder was -3.87+/-1.12 (SD). In one eye Urrets-Zavalia syndrome was noted as an early postoperative complication. In the second operated eye of another patient, there had been graft rejection several times. In this patient, frequent steroid use led to secondary glaucoma and he required filtering surgery. CONCLUSIONS Penetrating keratoplasty is effective and successful in treating iatrogenic keratectasia after LASIK, but these patients need a close and lifelong follow-up to treat lateterm complications such as graft rejection and secondary glaucoma.